How Does EMDR Work?

Eye Movement Desensitization and Reprocessing (EMDR) is a psychotherapeutic technique developed by Francine Shapiro in the late 1980s. Initially designed for treating post-traumatic stress disorder (PTSD), EMDR has gained recognition and popularity for its efficacy in addressing various psychological issues.¹ This article will explore the scientific underpinnings of EMDR therapy, its mechanisms of action, and empirical evidence supporting its effectiveness.

Theoretical Foundation of EMDR

EMDR therapy is grounded in the psychological theory, Adaptive Information Processing (AIP).^1-3  The AIP hypothesizes that traumatic experiences can overwhelm the brain’s ability to process information, leading to maladaptive memory storage.³ Maladaptive memory storage is the result of traumatic or distressing events that are stored in a way that is not properly integrated into the memory system. These unprocessed memories often manifest as distressing thoughts, feelings, and physical sensations, which can result in various physical and psychological issues.

In 1989, Shapiro proposed that EMDR facilitates the processing of these traumatic memories through specific eye movements and bilateral stimulation, to integrate these memories into a broader life narrative processing them in an adaptive way to facilitate healing.³ The therapy encourages victim-survivors to recall distressing memories while simultaneously engaging in bilateral sensory input, which is thought to help in reprocessing these memories.

Mechanisms Behind EMDR ^4-6

Dual Attention

Dual attention is believed to help process traumatic memories without becoming overwhelmed. Dual attention aids in: 

• Reducing emotional distress by directing attention to external stimuli, the victim-survivor can process the traumatic memory without becoming overwhelmed by the emotions associated with it. This helps to create a sense of safety during the processing of distressing memories.
• Cognitive processing keeps the mind engaged with both the memory and the sensory input may promote the reorganization of thoughts and feelings related to the trauma. This can lead to a cognitive shift, allowing victim-survivors to view their trauma from a new perspective.
• Integration through engaging in dual attention can facilitate the integration of traumatic memories into the victim-survivors broader life narrative, which can help reduce the intrusive symptoms associated with PTSD and other trauma-related disorders.

Bilateral Stimulation

Bilateral stimulation like sounds or taps that replicate the natural processing mechanisms of the brain. Bilateral stimulation aids in: 

• Brain hemisphere communication may enhance communication between the left and right hemispheres of the brain, which is important for adaptive processing of emotions and experiences. This bilateral engagement can help facilitate the integration of fragmented memories associated with traumatic events. 
• Physiological activation through bilateral stimulation can activate neural mechanisms associated with stress reduction and emotional regulation. Reducing physiological arousal, which can help individuals confront and reprocess traumatic memories while maintaining a calmer state in a safe environment. 
• Rhythmic, alternating movements of the eyes may mimic the eye movements that occur during Rapid Eye Movement (REM) sleep, a phase of sleep associated with processing and integrating memories. This process engages similar neurobiological processes to promote memory reconsolidation.

Memory Reconsolidation

Memory reconsolidation may help alter the emotional and cognitive perceptions of traumatic memories. It helps victim-survivors process traumatic events in less distressing and more manageable ways. This aligns with the memory reconsolidation theory, which suggests that previously stored memories are reactivated and can be modified during retrieval. This theory has important implications for EMDR therapy including: 

• When a traumatic memory is activated during EMDR, it enters a malleable state. The bilateral stimulation and dual focus during this period can aid in altering the emotional and cognitive response to that memory. This allows for the potential to “rewrite” the memory, reducing its power and the distress associated with it. 
• EMDR’s structured approach allows victim-survivors to reduce their avoidance of confronting the traumatic event. The confrontation during EMDR is in a controlled, supportive environment, thereby assisting victim-survivors in processing difficult memories without becoming overwhelmed. 

Cognitive Flexibility

Increases flexibility in thought and emotion as victim-survivors engage in EMDR they often report increased cognitive flexibility. Cognitive flexibility aids in: 

• Adaptability, as victim-survivors can start viewing their experiences from multiple perspectives rather than being locked into a single, traumatic viewpoint. This increased adaptability may carry over into their daily lives, improving overall mental resilience.
• Empowerment through facilitating recognition of strengths and coping mechanisms during therapy, victim-survivors can feel empowered in handling future stressors and challenges. 

EMDR as Evidence Based Research ^7-10

EMDR has gained recognition as an evidence-based treatment for trauma, rooted in somatic therapy principles that address the connection between the body and mind. Therapists practicing EMDR focus on helping individuals process and reframe distressing memories, integrating emotional and physical healing. Unlike CBT, which is widely accessible, EMDR requires an additional level of specialized training, limiting its availability to practitioners and contributing to some controversy surrounding its widespread implementation.

Over time, EMDR has evolved from an experience-based practice to an evidence-based intervention, demonstrating significant improvements in emotional regulation and reductions in PTSD symptoms. A comprehensive overview of EMDR highlights its success in reducing distress associated with traumatic memories, particularly when applied as an early intervention. When administered shortly after a traumatic event, EMDR has shown efficacy in preventing the escalation of acute stress into more chronic conditions, helping to mitigate long-term psychological effects.

Studies also emphasize EMDR’s effectiveness across diverse populations and age groups. While research supports its use for adults, its application with children and adolescents requires careful consideration to ensure techniques are developmentally appropriate. Tailoring EMDR to younger populations involves modifications that account for their cognitive and emotional stages, making it a valuable, though specialized, tool in addressing trauma at all ages.

A systematic review further underscores EMDR’s ability to alleviate trauma-related conditions such as depression and anxiety. Collectively, these studies affirm EMDR as a validated approach for trauma recovery, though its accessibility and specialized training requirements remain important factors in expanding its reach.

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